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Biomedical subjects

R Danner

Publications and source records attributed to R Danner.

At least 19 recordsLinked to original sources
PubMed2000

Questionnaire test-retest reliability: outcome measure of a vocational rehabilitation programme.

In a clinical follow-up case series study, the test-retest reliability of an outcome measure questionnaire was tested. The study group consisted of 48 patients who had taken part in a vocational rehabilitation programme. Test-retest reliability of a questionnaire was evaluated with the reliability index two years after entering the programme. It was found that the test-retest reliability of demographic data was rather good, although the questions concerning basic and occupational training showed instability over time. The answers concerning general health symptoms, mental working capacity and perceived changes in life during the past 12 months showed particularly high variability. The respondents' opinions on their general outlook of life seemed rather stable. Opinions about the perceived benefits from the intervention were marginally stable. The respondents' opinions about the benefits perceived from the physicians' work were more stable than the opinions about the perceived help from the other members of the rehabilitative team. It was concluded that an outcome analysis questionnaire is a useful tool to document the respondents' general and present perception of life and their present health situation as well as the rehabilitation process. The further development of generally applicable outcome measures for health promotion programmes will require unified, long-term efforts.

Adult↗
PubMed1999

[Psycho-neurogenic factors as a cause of life-threatening arrhythmias].

Tachyarrhytmias often occur during increased emotional arousal or mental excitation. The implantable cardioverter defibrillator (ICD) allows the exact documentation of arrhythmic episodes and their time of onset. Therefore, the type of arrhythmia can be differentiated as well as the circumstances surrounding the event. These features allow the assessment of possible psychic arrhythmogenic factors in the natural environment. We analyzed the ICD-protocols of three male patients (in ages between 60 and 68), whose devices had successfully terminated a ventricular tachycardia and compared the onset of the episodes with the patients' detailed descriptions of the corresponding life situations. The analysis of the circumstances at the time of arrhythmia-onset revealed a relationship between the occurrence of life-threatening arrhythmias in natural environment and emotional stress. The stressors could be defined as situations of increased vulnerability leading to sympathetic excitation. The induction of tachyarrhythmia was promoted in case 1 by acute psychic distress (public speaking), by the increasing panic-attack-like vicious circle of the cognitive anticipation of an unfavorable outcome (case 2), and an adverse anger reaction superimposed on persistent feelings of help- and hopelessness (case 3). These findings are in line with several experimental and epidemiological studies providing evidence for a relationship between psychic arousal and the induction of tachyarrhythmias. The knowledge of emotional and mental factors that function as a trigger for arrhythmias may lead to new therapeutic approaches in the prevention of sudden cardiac death.

Aged↗
PubMed1999

Sustaining and improving working capacity--programme description and two years follow-up.

In 1991 the Social Insurance Institution Rehabilitation Act introduced a working capacity sustaining and improving training programme (TYK). The goal of this programme is to sustain the physio-psycho-social competences of older workers and employees by creating a chain of in-house rehabilitation phases and training phases at the workplace. We describe the programme in its early state of implementation. Two years after entering the programme 17 patients were working, six were on sick leave, three were out of work, 16 were on pension, and six patients could not be retrieved.

Adult↗
PubMed1999

Long-acting psychotraumatic properties of a cardiac arrest experience.

OBJECTIVE: Progress in resuscitation medicine allows an increasing proportion of patients to survive an out-of-hospital cardiac arrest. However, little is known about long-term adaptation to the vital breakdown. The present study assessed the long-term prevalence and severity of emotional disability of cardiac arrest survivors and ascertained whether survivors suffer from recurrent and intrusive recollections of the cardiac arrest. METHOD: Follow-up analysis was performed on all cardiac arrest survivors discharged from the hospital over a 5-year interval (1990-1994) in a defined inner city and suburban area. From 118 initially hospitalized cardiac arrest survivors, 45 patients were discharged alive from the hospital. After a mean follow-up period of 39 months (range = 22-64), 25 patients exhibited sufficient cerebral performance for psychodiagnostic assessment; 21 patients were assessed. RESULTS: Despite an impaired ability to concentrate, cardiac arrest survivors had levels of psychological adjustment at follow-up that were similar to those of 35 cardiac patients whose clinical course was not complicated by cardiac arrest. However, the diagnosis of psychotraumatic symptoms in cardiac arrest survivors led to a sharp separation between favorable and nonfavorable outcome in affective regulation and level of functioning. Of the cardiac arrest patients, those with high scores of intrusion and avoidance (N = 8) reported an enduring sense of demoralization with significantly more somatic complaints, depression, anxiety, lack of confidence in the future, and narrowing of social activities than those with low scores (N = 11). Long-acting sedation at illness onset significantly predicted a favorable outcome. CONCLUSIONS: This study provides the first empirical evidence that the application of the posttraumatic stress disorder paradigm in the long-term evaluation of cardiac arrest survivors significantly contributes to defining a patient population at high risk for serious emotional disability.

Adaptation, Psychological↗
PubMed1998

Occupationally Oriented Medical Rehabilitation and Hairdressers' Work Techniques--A one-and-a-half-year follow-up.

This study examined changes in work techniques and musculoskeletal symptoms after occupationally oriented medical rehabilitation arranged for 21 hairdressers who were experiencing neck-shoulder or back pain but were still able to work. OWAS (Ovako Working Posture Analysing System) analyses of working postures and questionnaire data were obtained at the beginning of the courses and one and a half years later. The participants worked with their back bent and twisted or their arms at or over shoulder level more seldom (p <.0001) at the end of the follow-up than at the beginning of the rehabilitation. Subjective work-related physical and mental strain had decreased by 45.4% (p <.001) and 27.1% (p <.05), respectively, and subjective neck and back pain by 40.0% (p <.01) and 45.3% (p <.01), respectively. This study suggests that occupationally oriented medical rehabilitation can have significant and long-lasting effects on the rehabilitee's work techniques and subjective well-being.

Journal Article↗
PubMed1997

Effects of early defibrillation by ambulance personnel on short- and long-term outcome of cardiac arrest survival: the Munich experiment.

OBJECTIVES: This study evaluates the feasibility of implementing early defibrillation of out-of-hospital cardiac arrest patients for basic life-support providers (EMT-D) in a two-tier emergency system in the city of Munich, Germany. DESIGN: Retrospective consecutive analysis of all EMT-D attempts during a 5-year initiation phase (1990 to 1994) and prospective follow-up of all cardiac arrest survivors discharged from hospital. SETTING: A strictly defined inner-city and suburban area of 978 km2 and a residential population of 1,530,000 inhabitants with 22 ICUs in urban hospitals. One dispatching center to alert a two-tier emergency system with 56 EMT-D-staffed ambulances and physician-staffed mobile ICUs stationed at the nearest of nine hospitals. METHODS: AH EMT-D cases were identified and data on patients were documented in a standardized manner from patients' records, including the resuscitation protocol in the hospitals to which the patients were referred. For those patients discharged from the hospital, a standardized telephone interview was undertaken with the physician in charge of the patient and with the patient/relative leading to an assessment of the patient's status according to the Glasgow-Pittsburgh cerebral performance categories. INTERVENTION: None. RESULTS: During the 5-year initiation phase of the EMT-D program in the two-tier emergency system in Munich, there were 243 resuscitation attempts by EMTs, using the semiautomated defibrillator; 125 patients died immediately on the scene. In 118 patients, spontaneous circulation was reestablished and these patients were admitted to an ICU in 1 of the 22 urban hospitals. Median call-response interval for the EMT-D was 5 min (interquartile range, 3 to 6) and was 10 min (interquartile range, 7 to 13) for the second tier (p < or = 0.0001). In 34 cases (28.8%), EMT-D staff had reestablished spontaneous circulation (ROSC) before the second tier arrived on the scene. Patients with ROSC on the arrival of the second tier were more frequently discharged alive from hospital than were patients without ROSC at that time (p < or = 0.0001). The hospital discharge rate of initially successful resuscitated patients presenting with out-of-hospital ventricular fibrillation was 38.1% (45/118). Overall success rate of all EMT-D attempts was 18.5% (45/243). After a mean follow-up time of 39 (range, 22 to 64) months, 29 (66%) patients were still living. Twenty-five (56.8%) were neurologically not disabled or mildly disabled (CPC 1/2); disability was moderate in 3 (6.8%) patients and was severe in 1 (2.3%) patient. One case was lost to follow-up. CONCLUSION: The present study demonstrates that the upgrading of basic life support providers with semiautomated defibrillators has a significant benefit for cardiac arrest victims outside the hospital in an urban environment.

Ambulances↗
PubMed1989

Iatrogenic compartment syndrome, A follow-up of four cases caused by elastic bandage.

We describe four patients suffering from lower limb compartment syndromes which were caused by constrictive bandages applied after stripping of varices. The dressing was erroneously only partially removed, when the patients started complaining of severe pain and tension in the operated legs. The damages varied from extended irreversible neuromuscular defects to lesser functional handicaps. Three patients had corrective surgery. The clinical follow up over several years showed little improvement, secondary complaints were frequent.

Adult↗
PubMed1985

Seizures in an atelencephalic infant. Is the cortex essential for neonatal seizures?

Clinical and electrographic seizures were recorded in an infant with atelencephaly. Because the infant had no cerebral hemispheres, the ictal discharges were presumed to arise from the disorganized diencephalic derivatives that occupied the entire supratentorial space. The case provided strong support for the concept that, unlike epileptic seizures in older patients, some types of neonatal seizures may originate and propagate exclusively in subcortical structures. This may explain the striking dissociation between the electrographic and behavioral aspects of seizures occasionally observed in newborns, as well as the frequent intractability of such seizures to standard anticonvulsants.

Brain↗
PubMed1984

Cortical spike wave discharges during audiogenic convulsions in rats.

Audiogenic seizure-susceptible rats show high-amplitude spikes and waves in the electrocorticogram during the tonic phase of a maximal audiogenic convulsion. This observation establishes the validity of this seizure type as an animal model for human generalized epilepsy.

Acoustic Stimulation↗
PubMed1984

Prospective neurometric studies during the beginning of carbamazepine and phenytoin therapy.

We studied 23 epileptic outpatients to assess carbamazepine and phenytoin therapy effects on the peripheral nerve conduction velocity, the electromyogram, and the EEG background activity. Immediately before and 3, 5, 11, 22 months after beginning treatment with 300-800 mg carbamazepine or 200-400 mg phenytoin, the patients were examined with electroneuromyographic and quantified EEG tests. Carbamazepine, phenytoin, folate, and vitamin B12 serum concentration were simultaneously monitored. Clinical signs of intoxication or polyneuropathy were not observed. The mean serum concentrations were 29 mumol/l for carbamazepine and 43 mumol/l for phenytoin. There was little evidence that anticonvulsants' serum concentration at these levels are related to changes in the electroneuromyographic tests or the alpha rhythm.

Action Potentials↗